慢性乙型肝炎患者完全病毒抑制后体质指数的纵向变化与丙

StephenW

J Infect Dis. 2019 Aug 2. pii: jiz326. doi: 10.1093/infdis/jiz326. [Epub ahead of print]
Longitudinal Change of Body Mass Index Is Associated With Alanine Aminotransferase Elevation After Complete Viral Suppression in Chronic Hepatitis B Patients.
Wang K1, Lin W1, Kuang Z1, Fan R1, Liang X1, Peng J1, Guo Y1, Chen J1, Liu Z1, Hu X1, Wu Y1, Shen S1, Sun J1, Hou J1.
Author information

1
    State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Abstract
BACKGROUND:

Little is known about cause and intervention for alanine aminotransferase (ALT) elevation after complete viral suppression in patients with chronic hepatitis B (CHB).
METHODS:

In this prospective cohort study, patients with CHB who were treated with nucleos(t)ide analogs and maintained undetectable levels of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) for at least 6 months were enrolled. Patients were followed up at 6-month intervals, and anthropometric, biochemical, and virological assessments were performed.
RESULTS:

Of 1965 patients with median follow-up of 18.36 months, one third of patients experienced ALT elevation. Baseline high body mass index ([BMI] defined as ≥25 kg/m2), younger age, and liver cirrhosis independently increased the risk of longitudinal ALT elevation. At the end of follow-up, 89 (4.8%) patients reverted to low BMI, and 92 (5.0%) developed to high BMI. Compared with persistent high BMI, reversion to low BMI reduced the risk of ALT elevation (adjusted odds ratio [aOR], 0.38; 95% confidence interval [CI], 0.19-0.77); compared with persistent low BMI, onset of high BMI increased the risk of ALT elevation (aOR, 1.78; 95% CI, 1.02-3.11).
CONCLUSIONS:

High BMI is an independent predictor for ALT elevation after complete HBV DNA suppression. Improvement of BMI may have a beneficial effect on ALT normalization and even long-term outcomes.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
KEYWORDS:

ALT elevation; antiviral treatment; body mass index; chronic hepatitis B; complete viral suppression

PMID:
    31370059
DOI:
    10.1093/infdis/jiz326

StephenW

J Infect Dis。 2019年8月2日.pii：jiz326。 doi：10.1093 / infdis / jiz326。 [印刷前的电子版]
慢性乙型肝炎患者完全病毒抑制后体质指数的纵向变化与丙氨酸氨基转移酶升高有关。
Wang K1，Lin W1，Kuang Z1，Fan R1，Liang X1，Peng J1，Guo Y1，Chen J1，Liu Z1，Hu X1，Wu Y1，Shen S1，Sun J1，Hou J1。
作者信息

1
    南方医科大学南方医院传染病科，广东省病毒性肝炎研究重点实验室器官衰竭研究国家重点实验室，广州

抽象
背景：

对慢性乙型肝炎（CHB）患者完全病毒抑制后丙氨酸氨基转移酶（ALT）升高的原因和干预知之甚少。
方法：

在这项前瞻性队列研究中，登记了患有CHB的患者，这些患者接受核苷（酸）类似物治疗，并且维持检测不到的乙型肝炎病毒（HBV）脱氧核糖核酸（DNA）水平至少6个月。对患者进行6个月的随访，并进行人体测量，生化和病毒学评估。
结果：

在1965例中位随访18.36个月的患者中，三分之一的患者出现ALT升高。基线高体重指数（[BMI]定义≥25kg/ m2），年龄较小，肝硬化独立增加了纵向ALT升高的风险。随访结束时，89例（4.8％）患者恢复低BMI，92例（5.0％）发展为高BMI。与持续高BMI相比，恢复低BMI降低了ALT升高的风险（调整比值比[aOR]，0.38; 95％置信区间[CI]，0.19-0.77）;与持续的低BMI相比，高BMI的发病增加了ALT升高的风险（aOR，1.78; 95％CI，1.02-3.11）。
结论：

完全HBV DNA抑制后，高BMI是ALT升高的独立预测因子。 BMI的改善可能对ALT正常化甚至长期结果有益。

©The Author（s）2019。由牛津大学出版社出版，为美国传染病学会。版权所有。对于权限，请发送电子邮件至：[email protected]。
关键词：

ALT升高;抗病毒治疗;体重指数;慢性乙型肝炎;完全病毒抑制

结论：
    31370059
DOI：
    10.1093 / infdis / jiz326